There is scarce information about HIV-related cryptococcosis in the Brazilian Amazon basin where laboratory infrastructure is limited. The serum cryptococcal antigen (CrAg) lateral flow assay (LFA) has simplified diagnosis of cryptococcosis and is recommended for screening in advanced HIV disease. We evaluated the prevalence of cryptococcal antigenemia using finger-prick CrAg LFA in the Brazilian Amazon basin. We enrolled a prospective cohort of outpatients and hospitalized individuals with advanced HIV disease at two centers in Santarém Municipality, Northern Brazil. All individuals were > 18 years old with advanced HIV disease, regardless of antiretroviral therapy (ART) status and with no prior or current history of confirmed cryptococcal meningitis. We tested CrAg LFA on finger-prick whole blood using an exact volume transfer pipette. From August 2018 to October 2019, 104 individuals were enrolled (outpatients 62 [60%] and hospitalized 42 [40%]). Median age was 38 years (interquartile range [IQR] 30–46), and 84 (81%) were male. Sixty-five (63%) individuals were ART-naïve. Prevalence of finger-prick CrAg LFA-positive was 10.6%; 95% CI, 5.4 to 18.1%. Prevalence of finger-prick CrAg LFA-positive among individuals without neurological symptoms was 6.0%; 95% CI, 1.7–14.6%. The number needed to test to detect one CrAg-positive individual was 9.4 persons (95% CI, 5.5–18.5). Prevalence of cryptococcal antigenemia using finger-prick whole blood CrAg LFA was high. Point-of-care approach was important for the diagnosis and screening of cryptococcosis in resource-limited settings. Screening and preemptive therapy strategy should be urgently implemented in individuals with advanced HIV disease in the Brazilian Amazon basin.

中文翻译：

---

在巴西亚马逊盆地圣塔伦市的晚期 HIV 疾病患者中使用手指刺横向流动检测法检测隐球菌抗原血症的高流行率

在实验室基础设施有限的巴西亚马逊流域，关于 HIV 相关隐球菌病的信息很少。血清隐球菌抗原 (CrAg) 侧向流动检测 (LFA) 简化了隐球菌病的诊断，推荐用于晚期 HIV 疾病的筛查。我们在巴西亚马逊盆地使用手指刺 CrAg LFA 评估了隐球菌抗原血症的患病率。我们在巴西北部圣塔伦市的两个中心招募了一组前瞻性的门诊患者和住院晚期 HIV 患者。所有个体均＞18 岁患有晚期 HIV 疾病，无论抗逆转录病毒治疗 (ART) 状态如何，并且之前或当前没有确诊的隐球菌性脑膜炎病史。我们使用精确容量转移移液器在手指刺全血上测试了 CrAg LFA。从 2018 年 8 月到 2019 年 10 月，共有 104 人入组（门诊 62 [60%] 和住院 42 [40%]）。中位年龄为 38 岁（四分位距 [IQR] 30-46），84 人（81%）为男性。六十五 (63%) 人未接受过抗逆转录病毒治疗。手指刺 CrAg LFA 阳性的患病率为 10.6%；95% CI，5.4 至 18.1%。在没有神经系统症状的个体中，手指刺 CrAg LFA 阳性的患病率为 6.0%；95% 置信区间，1.7–14.6%。检测一名 CrAg 阳性个体所需的检测人数为 9.4 人（95% CI，5.5-18.5）。使用手指刺全血 CrAg LFA 的隐球菌抗原血症的患病率很高。在资源有限的环境中，即时护理方法对于诊断和筛查隐球菌病很重要。